EquiTrauma: Providing access to equitable trauma care in lower and middle income countries

Your Life is Our PriorityEnsuring equitable access to trauma care in lower and middle income countries. 

Our aim is to identify barriers in access to quality care for people who have been injured in lower and middle income countries, in particular Ghana, South Africa, and Rwanda.

This project is funded by the NIHR Global Health Policy and Systems Research (130036) and the Institute for Global Health Innovation at the University of Birmingham.

The views expressed are those of the authors and not necessarily those of the NIHR or the Institute of Applied Health Research. 

nihr logoKey researchers

Justine DaviesProfessor Justine Davies

Professor of Global Health

Institute of Applied Health Research

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Jean Claude ByringiroProfessor Jean Claude Byringiro

Co-PI NIHR Development Trauma Grant

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Project summary


Reducing deaths from trauma is a key Sustainable Development Goal (SDG 3.6), as is providing Universal Health Coverage (UHC: SDG 3.8). 

Currently, trauma accounts for more deaths than TB, malaria and HIV combined, with 90% of these deaths occurring in LMICs; trauma associated mortality is due to rise with projections that road traffic collisions will be the third leading cause of death by 2030 (they currently are the top killer for people 5-29 years old). 

Amongst trauma patients, timely access to quality care remains inequitable, with gaps in health services leading to barriers to care seen amongst those who are the poorest or otherwise vulnerable. Whilst reducing the occurrence of trauma is necessary, the universal provision of health systems to treat the inevitably injured is also required to improve health, wellbeing, and economic prosperity.

This project seeks to delineate barriers in access to trauma care in order to develop future interventions to ensure equitable access to trauma care for all. 

11th Annual Scientific Conference Rwanda Surgical Society

This project draws on the growing partnerships between University of Rwanda, University of Global Health Equity (Rwanda), Stellenbosch University (South Africa), University for Development Studies (Ghana) and University of Birmingham.  At the University of Birmingham, the project draws upon the strengths of the Institute of Applied Health Research in collaboration with the NIHR Surgical Reconstruction and Microbiology Centre (NIGR SRMRC), the Centre for Precision Rehabilitation for Spinal Pain (CPR Spine) and the Department for Political Science and International Studies on Global Health and Trauma Research. In this project we will delineate barriers that are causing delays in access to trauma care in Rwanda, Ghana and South Africa in order to make plans for future interventions. We will use qualitative methods to explore barriers in access to trauma care in rural and urban communities. Additionally, we will do workshops gathering service users, service providers, researchers and policy makers to develop context specific interventions to improve access to quality care for all. 

Setting


This qualitative and priority setting study will be done in one rural and one urban area in three countries; Ghana, South Africa, and Rwanda

Background

Maria Lisa Odland presenting on trauma and injuryAmongst trauma patients, timely access to quality care remains inequitable with gaps in health services leading to barriers to care seen amongst those who are the poorest or otherwise vulnerable. Non-fatal trauma is important and common. Most trauma studies have focused on care received in the facility (usually tertiary referral centre) setting. However, good trauma care requires that the patients seek, reach, receive, and remain in quality care. Unfortunately, very little evidence exists of the identity and extent of these barriers, solutions to overcome them, and their priority in lower- and middle-income countries (LMICs.) 

Aim

To identify barriers to access to quality care for people who have been injured in Ghana, South Africa, and Rwanda.

Objectives

In each country to:

1. Conduct a two day workshop with policy makers, infrastructure providers, service users and healthcare workers to identify barriers to access to quality injury care and prioritise solutions to overcome these barriers

2. Conduct focus group discussions with persons who have accessed care for injury to further explore barriers to access to care from the service user perspective

3. Conduct in-depth interviews with persons who have required injury care for themselves or their relatives to explore lived experiences of accessing healthcare for people who have been injured

4. Conduct a survey of experiences of healthcare for those who have been injured using a standardised questionnaire 

5. Conduct focus group discussions with community leaders to explore their experiences with or observations of barriers to accessing care amongst their community members

6. Convene a meeting of investigators, policy makers, and service user representatives at the end to discuss findings and outline future direction.

Expected outcomes

1. Publication in a peer reviewed journal

2. Policy briefs for reading by policy makers

3. Subsequent study protocol

Study limitations:

  • This study is only being conducted in three countries and may not be applicable to all LMICs. However, we have chosen three countries in different income status categories and with different geographical positions in sub Saharan Africa to ensure transferability. 
  • We are mostly focusing on qualitative data in this study which is a limitation. Quantitative data will be collected in planned future studies. 
  • This study only allows for exploration of barriers causing delays in access to quality care for the injured, and there is no focus on solutions. Nevertheless, the aim of this study is to create the basis for future studies with intervention design and implementation. 

Patient and public involvement

Patients and the public were not directly involved in the design of this study. However, through the workshops the service users and providers will have huge input in the direction of our work and influence future research and interventions. 

External advisor

Contact

Telephone:
+44(0)121 414 6348